Q2043 prior authorization | Anthem Blue Cross and Blue Shield Virginia
Q2043, Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion, is on the Anthem Blue Cross and Blue Shield Virginia HMO/EPO prior authorization list. Not a coverage or referral decision.
- Code
- Q2043
- Description
- Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion
- Source
- Virginia HMO/EPO standard precertification/prior authorization requirements, Pg 75 Original policy
Anthem Blue Cross and Blue Shield Virginia prior authorization